Braiatic Surgery
 
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Obesity: Is it a disease????
1. 10% of total population is obese
2. 20-25% of urban population are obese
3. 13% of adolescent population are obese
4 3% are severe to morbidly obese

  How we Indians Differ?
1. More fat with low B.M.I.
2. Central obesity
3. Varied cultures and eating habits
4 Social stigma
5. More vegetarians

  Classification
1. Overweight   26-29 B.M.I
  Obese   30-35 B.M.I
  Severely obese ≥ 35 B.M.I.
  Morbidly obese ≥ 40 B.M.I.
  Super obese ≥ 50 B.M.I.
  Super-super obese ≥ 60 B.M.I.

  Why loose weight?
1. Type II Diabetes/Insulin resistance
2. HTN/CAD
3. Sleep apnea/Asthma
4. Osteoarthritis
5. Dyslipidemia
6. PCOD/Infertility
7. Epilepsy/Pseudotumor
8. Depression
9. Incontinence
10 Back pain
11 GERD
12  Leg ulcers/Varicosity

  When to Operate ?
1.

2.		 B.M.I.

B.M.I.		 ≥

>		 40

37.5 with comorbidity

  Risks of Surgery?
1.
Very-very safe
2. Small but definite risks’
3. Bleed
4. Leak
5. Sepsis
6. Obstruction/hernia
7.
Food intolerance
8. Embolism
9. Protein-calorie
10. Malabsorption

  What Surgery?
1. Restrictive
2. Adjustable banding
3. Sleeve gastrectomy
4. Malabsorptive
5. Scopinaro’s BPD
6. BPD-DS
7. Combination
8. Roux-en-Y Gastric Bypass

Laparoscopic adjustable gastric banding

Roux-en-y Gastric Bypass



 

 Pathophysiologic Surgery to cure Type II Diabetes
1. Is it true?
2. Is it happening?
3. Does it help?

How does bariatric surgery resolve diabetes?
1. 80% Type II DM resolve
2. SAGB 48% remission (slow)
3. RYGB 84% remission (immediate)
4. BPD >95% remission (immediate)
  MS: Impact
1. Increase all cause mortality 2.Increase CVS mortality
How good is medicine for Type 2 DM (UK prospective diabetes study)
Patients  achieving FPG (<140mg%) target
After diet control 8%
After insulin  42%
After sulfonylurea 24%
Patients  achieving HbA1c target (< 7%)
After diet control 9%
After insulin  28%
After sulfonylurea 24%
       

  Metabolic syndrome
  1. 54 million Americans with metabolic syndrome!!!
  2. Central obesity with:
  3. SC fat in India
4. decreased bone mass in India with same BMI
5. Insulin resistance
                      fasting insulin
                      acute insulin response with
                      adiponectin

After bariatric surgery (T2DM resolved)
LAGB 48%
GASTROPLASTY 68%
RYGB 84%
BPD 98%
 
 
 
 
 
 
 
 
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